DVBCWNW3.m

DVBCWNW3 ;ALB/RLC NOSE, SINUS, ETC WKS TEXT - 1 ; 30 MARCH 2005

 ;;2.7;AMIE;**93**;Aug 7, 2003

 ;

 ;

TXT ;

 ;;A.  Review of Medical Records:

 ;;

 ;;

 ;;

 ;;B.  Medical History (Including Prior Treatment and Subjective Complaints):

 ;;

 ;;    1.  Location and nature of the injury or disease.

 ;;

 ;;

 ;;    2.  Treatment - type,(i.e., surgery, medications, oxygen, respirator, etc.),

 ;;        frequency, duration, response, and side effects.        

 ;;

 ;;

 ;;    3.  Subjective Complaints

 ;;

 ;;        Comment on presence or absence of each of the following:

 ;;    

 ;;        a.  Interference with breathing through nose.

 ;;

 ;;

 ;;        b.  Purulent discharge.

 ;;

 ;;

 ;;        c.  Dyspnea at rest or on exertion?

 ;;

 ;;

 ;;        d.  If speech impairment (ability to communicate by speech, 

 ;;            ability to speak above a whisper, etc.).

 ;;

 ;;

 ;;        e.  For disease or injury affecting soft palate, is there nasal

 ;;            regurgitation or speech impairment?

 ;;

 ;;

 ;;        f.  For chronic sinusitis, indicate which sinuses are affected and

 ;;            whether pain and headaches are present.  Describe severity and

 ;;            frequency.

 ;;

 ;;

 ;;        g.  If allergic attacks, frequency and baseline status between attacks.

 ;;

 ;;

 ;;        h.  Other symptoms noted.

 ;;

 ;;

 ;;        i.  Describe frequency and duration of periods of incapacitation 

 ;;            (defined as requiring bed rest and treatment by a physician).

 ;;

 ;;

 ;;C.  Physical Examination (Objective Findings):

 ;;

 ;;    Perform complete examination of area affected by disease and/or injury.

 ;;    Report all findings.  Additionally, comment on presence or absence of each

 ;;    of the following:

 ;;

 ;;    1.  For allergic and vasomotor rhinitis, indicate whether nasal polyps

 ;;        are present.

 ;;

 ;;

 ;;    2.  For bacterial rhinitis: Indicate whether there is evidence of

 ;;        granulomatous disease including rhinoscleroma.

 ;;

 ;;

 ;;    3.  When there is obstruction (partial or complete) of one or both

 ;;        nostrils, indicate percent of obstruction for each.

 ;;

 ;;

 ;;    4.  Sinusitis - Describe tenderness, purulent discharge, or crusting.

 ;;

 ;;

 ;;D.  Diagnostic and Clinical Tests:

 ;;

 ;;    1.  If there is stenosis of larynx, order FEV-1 with flow-volume loop.

 ;;    2.  If there is facial disfigurement, order COLOR PHOTOGRAPHS.

 ;;    3.  Include results of all diagnostic and clinical tests conducted

 ;;        in the examination report.

 ;;

 ;;

 ;;E.  Diagnosis:

 ;;

 ;;    Comment on whether the disease primarily involves or originates 

 ;;    from the nose, sinus, larynx, or pharynx.

 ;;

 ;;

 ;;Signature:                             Date:

 ;;END

--- Routine Detail   --- with STRUCTURED ROUTINE LISTING ---DVBCWNW3   2824     printed  Apr 23, 2025@18:07:26                                                                                                                                                                                                    Page 2

DVBCWNW3  ;ALB/RLC NOSE, SINUS, ETC WKS TEXT - 1 ; 30 MARCH 2005

 +1       ;;2.7;AMIE;**93**;Aug 7, 2003

 +2       ;

 +3       ;

TXT       ;

 +1       ;;A.  Review of Medical Records:

 +2       ;;

 +3       ;;

 +4       ;;

 +5       ;;B.  Medical History (Including Prior Treatment and Subjective Complaints):

 +6       ;;

 +7       ;;    1.  Location and nature of the injury or disease.

 +8       ;;

 +9       ;;

 +10      ;;    2.  Treatment - type,(i.e., surgery, medications, oxygen, respirator, etc.),

 +11      ;;        frequency, duration, response, and side effects.        

 +12      ;;

 +13      ;;

 +14      ;;    3.  Subjective Complaints

 +15      ;;

 +16      ;;        Comment on presence or absence of each of the following:

 +17      ;;    

 +18      ;;        a.  Interference with breathing through nose.

 +19      ;;

 +20      ;;

 +21      ;;        b.  Purulent discharge.

 +22      ;;

 +23      ;;

 +24      ;;        c.  Dyspnea at rest or on exertion?

 +25      ;;

 +26      ;;

 +27      ;;        d.  If speech impairment (ability to communicate by speech, 

 +28      ;;            ability to speak above a whisper, etc.).

 +29      ;;

 +30      ;;

 +31      ;;        e.  For disease or injury affecting soft palate, is there nasal

 +32      ;;            regurgitation or speech impairment?

 +33      ;;

 +34      ;;

 +35      ;;        f.  For chronic sinusitis, indicate which sinuses are affected and

 +36      ;;            whether pain and headaches are present.  Describe severity and

 +37      ;;            frequency.

 +38      ;;

 +39      ;;

 +40      ;;        g.  If allergic attacks, frequency and baseline status between attacks.

 +41      ;;

 +42      ;;

 +43      ;;        h.  Other symptoms noted.

 +44      ;;

 +45      ;;

 +46      ;;        i.  Describe frequency and duration of periods of incapacitation 

 +47      ;;            (defined as requiring bed rest and treatment by a physician).

 +48      ;;

 +49      ;;

 +50      ;;C.  Physical Examination (Objective Findings):

 +51      ;;

 +52      ;;    Perform complete examination of area affected by disease and/or injury.

 +53      ;;    Report all findings.  Additionally, comment on presence or absence of each

 +54      ;;    of the following:

 +55      ;;

 +56      ;;    1.  For allergic and vasomotor rhinitis, indicate whether nasal polyps

 +57      ;;        are present.

 +58      ;;

 +59      ;;

 +60      ;;    2.  For bacterial rhinitis: Indicate whether there is evidence of

 +61      ;;        granulomatous disease including rhinoscleroma.

 +62      ;;

 +63      ;;

 +64      ;;    3.  When there is obstruction (partial or complete) of one or both

 +65      ;;        nostrils, indicate percent of obstruction for each.

 +66      ;;

 +67      ;;

 +68      ;;    4.  Sinusitis - Describe tenderness, purulent discharge, or crusting.

 +69      ;;

 +70      ;;

 +71      ;;D.  Diagnostic and Clinical Tests:

 +72      ;;

 +73      ;;    1.  If there is stenosis of larynx, order FEV-1 with flow-volume loop.

 +74      ;;    2.  If there is facial disfigurement, order COLOR PHOTOGRAPHS.

 +75      ;;    3.  Include results of all diagnostic and clinical tests conducted

 +76      ;;        in the examination report.

 +77      ;;

 +78      ;;

 +79      ;;E.  Diagnosis:

 +80      ;;

 +81      ;;    Comment on whether the disease primarily involves or originates 

 +82      ;;    from the nose, sinus, larynx, or pharynx.

 +83      ;;

 +84      ;;

 +85      ;;Signature:                             Date:

 +86      ;;END